Lousy choices: Medicaid or the exchange

September 25. 2013 5:59PMThe “exchanges” mandated by Obamacare are supposed to be operational by next Tuesday. In New Hampshire, the state cannot even answer questions about whether people who might be eligible for subsidized insurance can be moved onto the exchanges.

New Hampshire lawmakers have not decided whether to expand Medicaid eligibility to 138 percent of the federal poverty level. Republican members of the state commission tasked with studying that issue want to know whether the state can move people who earn from 100 percent to 138 percent of the poverty level into subsidized insurance plans offered on the exchanges rather than put them on Mediaid.

“Recent guidance from CMS (Center for Medicaid Services) is they won’t grant a waiver unless there is a choice of qualified health plans,” Jennifer Patterson of the state Insurance Department told the commission. That is, these people probably will have to go onto Medicaid if New Hampshire expands eligibility because only one insurer offers plans through the exchange.

Why is that? Note Patterson’s phrase “qualified health plans.” The federal government mandates that all plans offered on the exchange must provide government-approved coverage that is broad and expensive. But the rates for those plans are set by the government. Only one insurer, New Hampshire’s biggest, was willing to play by those terms.

We are days away from the opening of the exchanges, and we have no competition. People are losing their employer-provided coverage, and the only option for many will be to go on Medicaid. What a reform.